1. The Effect of Introductory Training on the Use of Motivational Interviewing in Vocational Rehabilitation
David R. Higginbotham, MS – Louisiana Rehabilitation Services
Timothy N. Tansey, Ph.D., CRC – University of Wisconsin - Madison
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Introduction
Method
Results
In recent years, a number of state vocational rehabilitation agencies have adopted Motivational Interviewing (MI) as part of a process to revitalize the provision of vocational counseling and guidance in the federal/state vocational rehabilitation system. Miller and Rollnick (1991) defined MI as a “goal-oriented, consumer-centered counseling style for eliciting behavior change by helping consumers to explore and resolve ambivalence.” Wagner and McMahon (2004) noted that both MI and vocational rehabilitation counseling focus on resolving ambivalence to change and promote consumer self-determination through decision making, goal setting, and achievement.
MI has been recognized as a means to facilitate the development of a strong working alliance between the client and the therapist (Boardman, Catley, Grobe, Little, and Ahluwalia, 2006). Lustig, Strauser, Rice, and Rucker (2002) showed that a strong working alliance with the vocational rehabilitation counselor was associated with successful employment outcomes, job satisfaction for employed consumers, and a more positive outlook on future employment prospects for those who were unemployed.
Previous Studies
Manthey (2013) involved case managers who worked with individuals in supported employment services. Administration of the Motivational Interviewing Knowledge and Attitudes Scales – Vocational Rehabilitation (MIKAT-VR) pre- and post-training indicated that participation in an introductory MI skills training contributed to increased knowledge of MI and an attitude shift toward the use of MI in an employment focused setting.
Torres (2017) assessed the effect of a 4-hour standardized MI training and 4 weekly follow-up coaching sessions on consumer engagement and the working alliance with counselors. The pre- and post-training MIKAT-VR showed significant gains in MI competence among the counselors, a significant improvement in consumer engagement and working alliance with the clients. with the counselor among the clients whose counselors were in the experimental group.
Purpose
The purpose of this study was to assess whether a one-day introductory MI training could affect the perception of the participant’s ability to use MI as part of the vocational rehabilitation process.
Participants
Sixteen vocational rehabilitation staff members from the South Carolina Commission for the Blind (SCCB) participated in a one-day introductory MI workshop. Fourteen of the participants had a Master’s degree in Rehabilitation Counseling, one in Rehabilitation Counseling and Public Administration, and one in Public Administration. Eight of the participants were Certified Rehabilitation Counselors (CRC). Twelve of the 16 reported that they had not participated in MI training prior to the seminar.
Procedure
A pre- and post-training survey design was used to assess whether a one-day MI training program could affect how the participants perceived their ability to use MI as part of the vocational rehabilitation process. The survey was administered online through Survey Monkey and consisted of a 46 items assessing the use of MI in the vocational rehabilitation process across five topic areas including: Working Alliance (6), Consumer Engagement (8), Confidence in Using MI and the Underlying Principles (8), Barriers to Using MI (14), and the Effect of the use MI in Vocational Rehabilitation (10). The survey was composed of items developed by the Virginia Commonwealth University, Rehabilitation Research and Training Center. Each item was scored based on a five tier Likert scale: (1) Strongly Disagree, (2) Disagree, (3) Neutral, (4) Agree, and (5) Strongly Agree.
Motivational Interviewing Training
One-day seminar conducted by Tim Tansey, Ph.D. of the Department of Rehabilitation Psychology and Special Education, University of Wisconsin-Madison.
Materials
Motivational Interviewing for Vocational Counselors
Vocational Rehabilitation Technical Assistance Center for Targeted Communities (TC TAC): Project E3: Educate, Empower, and Employ.
Curriculum
1) Motivation to Work; 2) Perceived Work Barriers; 3) Career Development; 4) Job Interview and Impression Management; and 5) Job Retention. The program incorporates a group counseling treatment format and each module consists of structured content, requires about 90 minutes per session, and includes a homework assignment.
A paired sample t-test was used to assess whether there were statistically significant differences between the mean pre- and post-training ratings across the five areas of interest.
Confidence in using MI and the Underlying Principles
A statistically significant increase and moderate effect size (t = , p < .01; Cohen’s d = ) was observed between pre- and post-training. The factors that contributed to the result were the counselor’s confidence in using MI to help consumers resolve ambivalence about change in favor of change, ability to build rapport, manage resistance, and listen to the client instead of giving advice.
Barriers to using MI
A statistically significant reduction and moderate effect size (t = , p < .05; Cohen’s d = ) was observed between pre- and post-training. The factors that contributed to the result were collective support for using MI among coworkers, evidence that supports the use of MI in vocational rehabilitation, current use of MI to help clients deal with motivation to work issues, and proficiency in the use of MI to help consumers deal with psychosocial and vocational rehabilitation issues.
Area of Interest
Pre-Training
Post -Training
Mean SD
Confidence to Use MI
3.84
0.4715
4.11
0.3881
Barriers to Use of MI
3.26
0.2459
3.42
0.2412
Three of the five areas of interest did not show an effect related to the MI training. The pre- and post-training ratings for Working Alliance, Consumer Engagement, and the Use of MI in VR clustered around “Agree.” The only factor among these areas of interest that showed a moderate effect size (Cohen’s d = ) was observed in the Use of MI in VR and addressed the potential for the use of MI to improve the consumer’s involvement in the vocational rehabilitation process.
Area of Interest
Pre-Training
Post-Training
Mean SD
Working Alliance
4.15
4.01
Consumer Engagement
3.93
3.90
Use of MI in VR
3.89
This study represents another step in the development of a body of evidence that introductory, time-limited MI training can be an effective means for integrating MI into the vocational rehabilitation process. Additional research on the effect of introductory, time-limited MI training on counselor’s use of MI in the vocational rehabilitation process is warranted. Research to evaluate the effect of the use of MI on employment outcomes (i.e. MI versus Non-MI groups) and the quality of the employment (e.g. job match, salary, and benefits) is needed as part of the development of a comprehensive data base related to the use of MI in vocational rehabilitation. .
Acknowledgements:
The Program Evaluation and Quality Assurance Technical Assistance Center (PEQATAC)
Sukyeong Pi, Ph.D. – Michigan State University, Research Associate
Department of Counseling, Educational Psychology and Special Education .
The Stout Technical Assistance Center-Program Evaluation and Quality Assurance (SVRI-PEQA) is established under a grant from the Department of Education, Rehabilitation Services Administration (RSA) award number PR#H263B
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